OBJECTIVES:To verify the ability of super-resolution ultrasound (SRUS) microvascular imaging in assessing Takayasu's arteritis (TAK) activity and predicting prognosis. METHODS:Between November 2023 and July 2024, 70 patients with TAK were consecutively included; disease activity was assessed per the 1990 American College of Rheumatology classification criteria (26 active, 44 inactive). B-mode ultrasound (US), conventional contrast-enhanced ultrasound (CEUS), and SRUS microvascular imaging examinations were performed at the carotid site with maximal wall involvement using the Resona A20 system equipped with a SL10-3U linear transducer. We compared diagnostic performance of individual markers and combined models for disease activity and evaluated deterioration-free survival with Kaplan-Meier analysis. RESULTS:Carotid vasa vasorum was detected by SRUS microvascular imaging in 14 patients (11 active, 3 inactive), while it was not observed in the remaining 56 cases (41 inactive, 15 active). Presence of vasa vasorum correlated strongly with disease activity (p<0.001), demonstrating 42.3% sensitivity, 93.2% specificity, and 74.3% accuracy. The prediction model constructed based on clinical and US characteristics demonstrated high accuracy in assessing TAK activity (area under the curve=0.900). Among 41 patients completing follow-up (17 active, 24 inactive; mean 8.7±2.7 months), patients with inactive TAK maintained stable disease (only 1 relapsed to active phase). Among patients with active TAK, those with vasa vasorum demonstrated significantly poorer outcomes: only 2/7 (28.6%) achieved remission versus 9/10 (90%) without vasa vasorum (p=0.036). CONCLUSIONS:SRUS detection of carotid vasa vasorum serves as a useful indicator for assessing the activity and severity of TAK.

As a rare biliary tract tumor, intraductal papillary neoplasm of the bile duct (IPNB) is most common in elderly men and can progress to cholangiocarcinoma- (CCa) if left untreated. It is reported that IPNB usually communicates with the bile duct. As a result, the downstream bile ducts are imaged asymmetrically dilated. However, a case of IPNB that we report here is different. Enhanced MRI revealed a lack of connectivity with the bile duct in this case. Based on this, the purpose of this case study is to suggest that the majority of imaging doctors should widely understand the various imaging manifestations of the disease to avoid misdiagnosis. In addition, although this feature was not indicated by ultrasound in this case, given previous studies and considering the convenience and non-ionizing radiation damage of CEUS, we recommend its use as a screening method for IPNB to improve diagnostic accuracy.

PURPOSE:The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. METHODS:This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. RESULTS:Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). CONCLUSION:Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.

This study aimed to develop and validate an ultrasound (US)-based nomogram for the preoperative differentiation of renal urothelial carcinoma (rUC) from central renal cell carcinoma (c-RCC). Clinical data and US images of 655 patients with 655 histologically confirmed malignant renal tumors (521 c-RCCs and 134 rUCs) were collected and divided into training (n = 455) and validation (n = 200) cohorts according to examination dates. Conventional US and contrast-enhanced US (CEUS) tumor features were analyzed to determine those that could discriminate rUC from c-RCC. Least absolute shrinkage and selection operator regression was applied to screen clinical and US features for the differentiation of rUC from c-RCC. Using multivariate logistic regression analysis, a diagnostic model of rUC was constructed and visualized as a nomogram. The diagnostic model’s performance was assessed in the training and validation cohorts by calculating the area under the receiver operating characteristic curve (AUC) and calibration plot. Decision curve analysis (DCA) was used to assess the clinical usefulness of the US-based nomogram. Seven features of both clinical features and ultrasound imaging were selected to build the diagnostic model. The nomogram achieved favorable discrimination in the training (AUC = 0.996, 95

The diagnostic value of Bosniak classification based on contrast enhanced ultrasound (CEUS) on complex cystic renal mass (CRM) was compared among different observers. From 2012 to 2022, 212 complex CRMs, confirmed by pathology or at least 1-year imaging follow-up, were enrolled. The CEUS images of CRM were retrospectively analyzed by two reviewers with different experience in kidney CEUS examination, and each lesion was given the categorizations according the Bosniak ver. 2015 and ver. 2019, respectively. There was good inter-observer agreement (k = 0.689; p < 0.05) for Bosniak ver. 2019. With Bosniak ver. 2019, senior and junior reviewer correctly classified 44 (83.02%), 40 (75.47%) benign lesions as low grade (Ⅰ ∼ ⅡF), and 94 (94.95%), 80 (80.81%) malignant tumors as high grade (Ⅲ or Ⅳ), respectively. Meanwhile, the combination of Bosniak 2019 and senior reviewer demonstrated the highest area under the receiver operating characteristic curve (Az: 0.875, all p < 0.05) than other groups, with the highest specificity (81.10%) and sensitivity (93.90%) among all the groups (95% CI, 0.807–0.943; p < 0.05), respectively. Overall, the senior reviewer combined with Bosniak ver. 2019 was the best choice for the diagnosis of complex CRM.

目的 探讨超声造影(contrast-enhanced ultrasound,CEUS)联合2019版Bosniak分级(B2019)在肾脏囊性占位(cystic renal mass,CRM)诊断中的应用价值.方法 分析2011 年10月至2021年10月复旦大学附属中山医院收治的经手术病理证实的99例CRM患者共99个病灶的病例资料,所有病灶均分别按照B2019、2005版Bosniak分级(B2005)进行评价.采用ROC曲线评价CEUS+B2019和CEUS+B2005对CRM的诊断效能.结果 CEUS+B2019及CEUS+B2005诊断CRM的曲线下面积(area under curve,AUC)分别为 0.943、0.885,差异有统计学意义(P＜0.05).CEUS+B2019 诊断CRM的特异度、准确度分别为97.80%、93.94%,明显高于CEUS+B2005(84.40%、88.89%),灵敏度为90.70%,低于CEUS+B2005(92.60%),差异均有统计学意义(均P＜0.05).CEUS+B2019、CEUS+B2005 诊断CRM的Kappa值分别为0.879、0.775.结论 在CRM的诊断中,CEUS+B2019 较CEUS+B2005 有更高的特异度、准确度,有助于避免良性CRM的误诊,减少不必要的随访及过度治疗.

Hypoxia, the typical and conspicuous characteristic of most solid tumors, worsens the tumor invasiveness and metastasis. Here, we engineered a sequential ultrasound (US)/hypoxia-sensitive sonochemotherapeutic nanoprodrug by initially synthesizing the hypoxia-activated azo bond-containing camptothecin (CPT) prodrug (CPT2-Azo) and then immobilizing it into the mesopores of sonosensitizer-integrated metal organic frameworks (MOF NPs). Upon entering the hypoxic tumor microenvironment (TME), the structure of CPT2-Azo immobilized MOFs (denoted as MCA) was ruptured and the loaded nontoxic CPT2-Azo prodrug was released from the MOF NPs. Under US actuation, this sonochemotherapeutic nanoprodrug not only promoted sonosensitizer-mediated sonodynamic therapy (SDT) via the conversion of oxygen into cytotoxic reactive oxygen species (ROS) but also aggravated hypoxia in the TME by elevating oxygen consumption. The exacerbated hypoxia in turn served as a positive amplifier to boost the activation of CPT2-Azo, and the controllable release of toxic chemotherapeutic drug (CPT), and compensated the insufficient treatment efficacy of SDT. In vitro and in vivo evaluations confirmed that sequential SDT and tumor hypoxia-activated sonochemotherapy promoted the utmost of tumor hypoxia and thereby contributed to the augmented antitumor efficacy, resulting in conspicuous apoptotic cell death and noteworthy tumor suppression in vivo. Our work provides a distinctive insight into the exploitation of the hypoxia-activated sonochemotherapeutic nanoprodrug that utilizes the hypoxic condition in TME, a side effect of SDT, to initiate chemotherapy, thus causing a significantly augmented treatment outcome compared to conventional SDT.

肾脏囊性占位（cystic renal mass,CRM）是指以囊性表现为主的一类肾脏占位性病变,在临床中较常见,占所有肾脏疾病的10%～15%,有良性及恶性之分。本文总结了不同病理类型良性CRM的声像图特点,重点讨论了常规超声、超声造影（contrast-enhanced ultrasound,CEUS）等不同超声检查技术在该类疾病诊断中的应用,旨在提高临床诊断的准确率,减少误诊,避免临床过度治疗。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change(CRCCC).Methods The ultrasonographic datas of 82 lesions in 82 patients with complicated renal cysts or CRCCC confirmed by pathology were analyzed.The characteristics of conventional ultrasound and CEUS were observed and evaluated.The lesions were graded according to Bosniak classification criteria.Results Pathological examination showed that 36 cases were complicated renal cysts and 46 cases were CRCCC. Routine ultrasound showed there were 9 cases (25.0％) with cystic masses and 27 cases (75.0％) with solid and cystic masses in complex renal cysts,of which 14 cases (38.9％) could detect color flow signals.In CRCCC,2 cases(4.3％)were with cystic masses and 44 cases(95.7％)were with solid and cystic masses, of which 33 cases(75.0％)could detect color flow signals.CEUS showed that only 18 cases(50.0％)of the complex renal cysts showed enhancement of cystic wall or septum,with equal or low enhancement at the peak,9 cases(50.0％) accompanied by decrease of renal cortex,35 cases (97.2％) had thin and regular cystic wall,no enhancement of cystic wall in all lesions,and 33 cases(91.7％)had septal thickness less than 1 mm.Forty-five cases (97.8％) of CRCCC showed enhancement of cystic wall or septum,40 cases(88.9％)showed equal or high enhancement at peak,30 cases(66.7％)were faster than the decrease of renal cortex,37 cases (80.4％) showed uneven thickness of cystic wall,24 cases (52.2％) showed enhancement of cystic wall nodules,and 28 cases (60.9％) showed uneven thickness of septum.After CEUS,33 cases(91.7％)of complex renal cysts were classified as grade Ⅰ and Ⅱ,while 42 cases(91.3％) of CRCCC were classified as grade Ⅲ and Ⅳ.Conclusions The CEUS manifestations of complex renal cysts are different from those of CRCCC.The application of Bosniak criteria in CEUS is helpful for the differential diagnosis of complex renal cysts and CRCCC.